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Old 01-16-2012
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Kids Pediatric Hyperbilirubinemia

A full-term normal male breast-fed infant develops a slight yellow color to his skin on his sixth day of life. Laboratory examination finds his serum bilirubin levels to be slightly elevated (due to increased indirect bilirubin), but the levels are less than 6 mg/dL. Additionally, serum hemoglobin levels are within normal limits. The elevated bilirubin levels last for about 5 weeks. Which of the following is the most likely cause of these signs and symptoms?

A. Breastfeeding jaundice
B. Breast milk jaundice
C. Hemolytic disease of the newborn
D. Inspissated bile syndrome
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Old 01-16-2012
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i would go with Breast milk jaundice seen in newborns breast feed due not well developed udp glucuronyl conjugation system.

breast feeding jaundice is seen in infants not brest feed so lack of enteral stimulation and peristalsis to secrete bile.

hemolytic jaundice no as infants hb is normal
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Old 01-16-2012
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ans : B.............
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Old 01-17-2012
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EXPLANATION: Breast milk jaundice is a cause of neonatal jaundice that begins between days 4 and 7 of life. In contrast, physiologic jaundice of the newborn refers to mild elevation of the serum bilirubin levels that begins on days 2 to 4 of life. This abnormality is generally the result of decreased levels of bilirubin UDP-glucuronosyl transferase (UGT), while breast milk jaundice may be due to hormones in breast milk (possibly beta-glucuronidases) that inhibit UGT. It is important to clinically differentiate breast milk jaundice from physiologic jaundice of the newborn in order to predict the length of the hyperbilirubinemia. The elevated indirect bilirubin with breast milk jaundice persists longer (up to 6 weeks) than physiologic jaundice (usually less than 2 weeks). Also note that breast milk jaundice is different from breastfeeding jaundice, which occurs before first 4 to 7 days of life and is caused by insufficient breast milk (decreased plasma volume).
With these abnormalities the increased serum bilirubin is mainly unconjugated (indirect) bilirubin. In full-term infants, the maximum bilirubin levels are less than 6 mg/dL (normal is less than 2 mg/dL). It is important to realize that in newborns the blood-brain barrier is not fully developed and unconjugated bilirubin may be deposited in the brain, particularly in the lipid-rich basal ganglia, producing severe neurologic abnormalities. Grossly the brain has a bright yellow pigmentation that is called kernicterus. Note that kernicterus does not result unless serum bilirubin levels are greater than 20 mg/dL. Treatment, if needed, consists of exposing the skin to light (440 to 470 nm), which activates oxygen and converts bilirubin to photobilirubin. This substance is hydrophilic and can be excreted in the urine.
Finally, with hemolytic disease of the newborn serum hemoglobin levels are decreased, while inspissated bile syndrome, which can contribute to jaundice, is seen in neonates with sepsis in which thick bile can cause obstruction.
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Hitman (01-17-2012)


Biochemistry-, Gastrointestinal-Tract-, Pathology-, Pediatrics-, Step-1-Questions

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